Schneider Laura, Farrokhyar Forough, Schieman Colin, Hanna Waël C, Shargall Yaron, Finley Christian J
Department of Surgery, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
Department of Surgery, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
Eur J Cardiothorac Surg. 2015 Jul;48(1):65-70. doi: 10.1093/ejcts/ezu427. Epub 2014 Nov 24.
Pulmonary lobectomy is the most commonly performed surgery for lung cancer and remains the gold standard operative treatment. The reported surgical mortality from this procedure rarely differentiates between in-hospital mortality (IHM) and early post-discharge mortality (PDM). We aimed to examine the IHM and 90-day PDM over time and identify outcome predictors including patient characteristics, comorbidity and system-level factors.
Data for patients who underwent lobectomy from 2005 to 2011 were acquired from a linked Ontario population-based database. Exclusions included patients undergoing sleeve lobectomy, resections for synchronous lesions, previous lung malignancy and extended length of stay (LOS) over 30 days. We reported proportional mortality and cumulative survival attributable to IHM and PDM with confidence intervals. Multivariate logistic and Cox regression analyses were performed to examine the role of variables associated with IHM and 90-day PDM.
For 5389 patients who underwent lobectomy for non-small-cell lung cancer, the median LOS was 6 (1-30) days. IHM (n = 73) was 1.4% (1.1-1.6%) and PDM (n = 101) was an additional 1.9% (1.6-2.3%) within 90 days post-lobectomy discharge. Logistic regression suggested that age [odds ratio (OR): 1.5 (1.3-1.8)], myocardial infarction [OR: 3.6 (1.8-7.0)], congestive heart failure [OR: 5.8 (2.4-13.8)], chronic obstructive pulmonary disease [OR: 1.9 (1.1-3.2)], preoperative positron emission tomography [OR: 2.7 (1.1-7.0)], peptic ulcer disease [OR: 22.1 (4.1-117.4)], hemiplegia [OR: 15.8 (1.8-141.1)], other primary cancer [OR: 0.5 (0.3-0.8)] and year of surgery [OR: 1.0 (0.8-1.0)] were potential predictors of IHM. Length of hospital stay [hazard ratio (HR): 1.1 (1.0-1.1)], male gender [HR: 1.5 (1.0-2.3)], age [HR: 1.1 (1.0-1.3)] and metastatic cancer [HR: 2.6 (1.7-4.0)] were potential predictors of PDM.
PDM represents a substantive, under-reported burden of mortality due to lobectomy. More than half of post-lobectomy mortality occurs post-discharge and the annual rate remained unchanged, while IHM decreased with time, suggesting that the improvement seen in mortality might be exclusive to the smaller IHM. Patient factors play a significant role in both IHM and PDM. We emphasize that this identifies the importance of appropriate patient selection, further investigation of risk factors and particular attention to these risk factors during regular follow-up visits to improve PDM in this high-risk patient population.
肺叶切除术是肺癌最常施行的手术，仍是手术治疗的金标准。该手术报告的手术死亡率很少区分住院死亡率（IHM）和出院后早期死亡率（PDM）。我们旨在研究不同时间的IHM和90天PDM，并确定包括患者特征、合并症和系统层面因素在内的预后预测因素。
从安大略省一个基于人群的关联数据库中获取2005年至2011年接受肺叶切除术患者的数据。排除标准包括接受袖状肺叶切除术的患者、同步病变切除术、既往肺部恶性肿瘤以及住院时间（LOS）超过30天的患者。我们报告了归因于IHM和PDM的比例死亡率和累积生存率及其置信区间。进行多变量逻辑回归和Cox回归分析以研究与IHM和90天PDM相关变量的作用。
对于5389例接受非小细胞肺癌肺叶切除术的患者，中位LOS为6（1 - 30）天。肺叶切除术后出院90天内，IHM（n = 73）为1.4%（1.1 - 1.6%），PDM（n = 101）额外为1.9%（1.6 - 2.3%）。逻辑回归表明，年龄[比值比（OR）：1.5（1.3 - 1.8）]、心肌梗死[OR：3.6（1.8 - 7.0）]、充血性心力衰竭[OR：5.8（2.4 - 13.8）]、慢性阻塞性肺疾病[OR：1.9（1.1 - 3.2）]、术前正电子发射断层扫描[OR：2.7（1.1 - 7.0）]、消化性溃疡疾病[OR：22.1（4.1 - 117.4）]、偏瘫[OR：15.8（1.
